Whom do we trust on the NHS: elected ministers or trade unions?

"The National Health Service is the closest thing the English have to a religion, with those who practise in it regarding themselves as a priesthood. This made it quite extraordinarily difficult to reform. For a bunch of laymen, who called themselves the Government, to presume to tell the priesthood that they must change their ways in any respect whatever, was clearly intolerable. And faced with a dispute between their priests and ministers, the public would have no hesitation in taking the part of the priesthood."

So wrote Nigel Lawson in his memoirs. Is it still true, though? In other fields of government, we expect vested interests to resist reform. No one is especially surprised when Police Authorities oppose elected police chiefs, or when Local Education Authorities attack the notion of parental choice. Do we mentally file NHS bureaucrats and unions in a different category?

The ministry to which Lawson belonged was widely believed to despise the NHS, for all that it doubled the healthcare budget during its 17 years in office. No one, by contrast, can seriously doubt David Cameron's commitment to the existing state-run healthcare model. He wants to expand it, and has exempted the NHS from the budgetary savings which every other branch of government is expected to find. For what it's worth, I disagree with him – no other country wants to copy the British system, which delivers worse outcomes at greater cost than in most developed states – but he is obviously sincere. And if we absolutely must maintain a government monopoly in healthcare, it at least makes sense to devolve decision-making from central bureaucracies to local clinicians, and to shift spending from administration to front-line treatment.

The public sector unions seem to have calculated that no one will bother looking at the details, that anything the Tories do will be assumed to be malevolent and that, in short, they will automatically be accorded the sacerdotal respect of which Lawson wrote. Twenty years ago, this would probably have been the case. But my sense is that public attitudes are shifting.This morning's Guardian, for example, complains bitterly about surgical operations being deferred or cancelled because of the current rationing system. If Andrew Lansley can remedy such problems, his reforms will turn out to be popular as well as right.